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Theory & Practice II > Therapeutic Exercise for the Ankle and Foot > Flashcards

Therapeutic Exercise for the Ankle and Foot Flashcards

1
Q

Pronation is the combination of what motions

A
  • dorsiflexion
  • eversion
  • abduction
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2
Q

Supination is the combination of what motions

A
  • plantar flexion
  • inversion
  • adduction
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3
Q

What muscles do planatrflexion

A

Primary: gastroc and soleus
Secondary: tibialis posterior, flexor halluces longus, and flexor digitorum longus

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4
Q

What muscles dorsiflex

A
  • tibialis anterior
  • extensor halluces longus
  • extensor dititorum longus
  • fibulas tertius
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5
Q

What muscles do eversion

A
  • fibulas longus
  • fibulas brevis
  • fibulas tertius
  • extensor digitorum
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6
Q

What muscles do inversion

A
  • tibialis anterior
  • tibialis posterior
  • extensor halluces longus
  • flexor digitorum longus
  • flexor halluces longus
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7
Q

Line of gravity through the body in quiet standing

A
  • anterior to ankle
  • anterior to knee
  • posterior to hip
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8
Q

Loading response progressing to mid stance

A
  • foot pronation and lower leg IR
  • loose packed position
  • conforms to surface
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9
Q

Mid stance progressing to terminal stance

A
  • foot supination and lower leg ER
  • closed pack position
  • creation of rigid level via windlass effect
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10
Q

When are dorsiflexors active during gait

A
  • initial contact and loading response
  • control foot lowering to the ground
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11
Q

When are plantar flexors active during gait

A
  • eccentrically and concentrically during mid stance into terminal stance
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12
Q

When are evertors active during gait

A
  • provide mediolateral stability & prevents involuntary ankle inversion at foot strike
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13
Q

When are investors active during gait

A
  • Tibialis ant./pos. function to control pronation during loading response
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14
Q

When are intrinsics active during gait

A
  • support transverse & longitudinal arches
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15
Q

Intrinsic factors of leg, heel, and foot pain

A
  • pes caves foot type
  • high BMI
  • decreased ankle DF
  • weak intrinsic musculature
  • faulty LE alignment
  • female
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16
Q

Extrinsic factors of leg, heel, and foot pain

A
  • running
  • increase in exercise routine volume
  • work demands
  • improper footwear
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17
Q

Tendinosis, tendonitis, and tenosynovitis of the foot

A
  • commonly in the anterior/posterior tibialis, fibulas muscle tendons, or Achilles tendon
  • exacerbated with stretch, resistance, and palpation
  • Achilles tendon symptoms usually 2-6 cm above the insertion site
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18
Q

Anterior versus posterior shin splints

A
  • Anterior: overuse & weakness of the ant. tibialis, decreased ROM of gastroc-soleus complex
  • Posterior: posterior tibialis weakness/inflammation, tight gastroc-soleus complex, increased foot pronation
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19
Q

Protection phase for non-operative heel/foot pain

A
  • treat local inflammation (POLICE)
  • cross friction massage
  • submax muscle setting contractions
  • passive stretch to plantar flexors
  • AROM within pain free range
  • activity modification or avoidance
  • supportive taping or orthotic prescription
20
Q

Controlled motion phase for non-operative heel/foot pain

A
  • assess entire kinematic chain once scute symptoms are alleviated
  • pain with initial WBing/first few steps
  • educate on gentle warm uo before aggressive exercise, recovery time, and footwear
  • stretch plantar fascia with great toe extension & eversion
  • progress resistive exercises as tolerated in both open/closed chain positions
  • intrinsic foot muscle strengthening is beneficial for pt’s with plantar fascia
21
Q

Achilles tendon rupture risk factors

A
  • 4th/5th decade of life
  • males more likely than females
  • jumping or landing task
  • degenerative & mechanical factors increase risk
  • use of quinolone antibiotics & pre injury steroid injections in the tendon increase risk
  • typically surgery for younger persons looking to return to sport
  • conservative care for older or more sedentary individuals
22
Q

Post operative management for an Achilles tendon repair

A
  • no more than 2 weeks of protected WBing
  • use of protective device for 2-4 weeks post-op
  • avoid early end range AROM DF
  • outcome measures: foot & ankle ability measure (FAAM) and achilles tendon total rupture score (ATRS)
23
Q

Weight bearing guidelines post-op Achilles tendon repair

A
  • WBAT w/crutches immediately after surgery or after 1-2 wks in a CAM boot
  • progress gradually to full WBing status between weeks 3-6 post-op
  • orthosis is worn during all WBing activities for 6-8 wks after surgery
  • FBW w/o orthosis using shoes w/bilateral heel lifts can begin around 6-8 wks post-op (remove 1 heel lift every 1-2 wks)
24
Q

ROM guidelines post-op Achilles tendon repair

A
  • AROM immediately or within first 1-2 wks post-op (avoid 15-20 degrees of DF)
  • Wks 4-6: with orthosis removed begin INV/EV with ankle in PF
  • Wks 6-8: progress to DF beyond neutral up to 10 degrees with orthosis & progress INV/EV
25
Q

Criteria to discontinue CAM boot

A
  • 0 degrees DF AROM
  • pain free ambulation (non-antalgic)
  • full discontinue of boot & shoe lifts by wk 8
26
Q

Max protection phase post-op to 2 wks for Achilles tendon repair

A
  • Precautions: maintain post-op splint or cast per surgeon
  • joint mobilizations
  • initiate PROM if patient is in removable splint
  • PF as tolerated
  • DF to minimal stretch (DO NOT stretch aggressively)
  • initiate foot intrinsic exercises
  • toe taps, arch doming, toe spreading, towel crunches
  • ankle AROM/alphabets
  • SLR 4-way
  • all exercises should be pain free
27
Q

Transition to moderate protection phase post-op Achilles tendon repair

A
  • wks 2-6
  • initiate pain free AROM PF, INV, EV, and continue PROM
  • initiate weight shifts out of boot wk 4 as tolerated
  • seated heal raises
  • BAPS board seated as tolerated
  • recumbent bike with CAM boot
  • glute & lumbopelvic strength & stability
28
Q

Exercises to initiate at 4 wks post-op Achilles tendon repair

A
  • progressive resisted PF, INV, and EV with TheraBand
  • seated heel raises with lightweight
  • balance/proprioceptive training on stable surface once able to WB in neutral ankle position out of boot
  • standing BAPS board as tolerated (PWB or FWB)
  • light weight double leg press
29
Q

Strength phase post-op Achilles tendon repair

A
  • wks 6-12
  • full PROM/AROM PF, INV, and EV
  • joint mobilizations
  • balance training on unstable surface
  • closed chain hip & knee strengthening
  • recumbent bike in shoe
  • Wk 8: standing heel raise progression as able & double leg starting in neutral ankle DF
  • Wk 10: step holds with focus on LE alignment & balance & heel taps
30
Q

Minimum protection phase post-op Achilles tendon repair

A
  • begins about wks 12-16
  • heel lowering exercises in unilateral stance
  • descending stairs step over step
  • plyometric training started in pool
  • functional criteria dictates return on over ground plyometrics & running programs
31
Q

Functional phase post-op Achilles tendon repair

A
  • emphasize strengthening at end range plantarflexion
  • heels raises in knee flexion
  • continued progression of strength/stability/balance exercise on stable/unstable surfaces to correct altered mechanics
  • initiate plyometric progression
  • step/hop holds for training on LE landing mechanics for jogging
  • resisted jogging in place with resistance in all planes
  • sports specific exercise/agility progression
32
Q

Criteria to initiate return to running/jumping post-op Achilles tendon repair

A
  • btw wks 12-16
  • 95% symmetry ROM
  • 95% symmetry calf circumference
  • normalized gait & jogging mechanics
  • 25 single leg heel raises with heel height within 25% of uninvolved limb
33
Q

Criteria for return to sport post-op Achilles tendon repair

A
  • b/w 6-9 months
  • physician clearance
  • 95% symmetry ROM
  • normalized gait & jogging mechanics
  • < or equal to 10% PF strength difference in 0 degrees DF and < or equal to 25% PF strength difference in 20 degrees PF
  • 90% symmetry on Y-balance test
  • 90% symmetry on SL hop testing
34
Q

Intrinsic versus extrinsic factors for ankle sprain

A
  • Intrinsic: previous sprain & decreased DF ROM
  • Extrinsic: athletic participation without bracing, poor warmup, poor participation in balance.proprioceptive training
35
Q

Max protection phase for Anke sprain

A
  • Estim and US have no benefit
  • ice to control swelling for first 24-48 hrs
  • provide brace, walking boot, semi-rigid orthotic to facilitate progressive WBing
  • joint mobs
  • sagittal plane AROM
  • muscle setting and toe curls for muscle integrity & circulation
36
Q

Controlled motion phase for ankle sprain

A
  • continued bracing/support
  • normalize gait
  • cross friction massage
  • joint mobs
  • progress resistance training but avoid end range
  • stretch gastroc-soleus complex
  • progress to single limb balance training
37
Q

Return to function phase for ankle sprain

A
  • TheraBand resistance ankle exercises in open chain
  • neuromuscular reduction training in full weight bearing
  • dynamic gait patterns
  • balance training on unstable surfaces
  • plyometrics
38
Q

Plantar Fasciitis

A
  • inflammation of the plantar fascia
  • pain on bottom of foot usually towards heel
  • overuse injury
39
Q

Intrinsic versus extrinsic factors for plantar Fasciitis

A
  • Intrinsic: obesity, reduced strength in PF, reduced ROM in DF, & foot/LE structural abnormalities
  • Extrinsic: new excessive amounts of exercise, improper footwear, & training on surfaces with no cushion
40
Q

Symptoms of plantar Fasciitis

A
  • plantar medial heel pain
  • sharp or aching pain in arch at rest or during WBing
  • excessive pronation
  • delayed supination
  • limited DF
  • pain with first steps in morning/after rest
41
Q

Special tests for Plantar Fasciitis

A
  • Windlass test (patient seated with knee bent to 90 degrees, lift great toe MTP while allowing IP to flex; pos. = pain & limited ROM)
  • palpation of the plantar medial tubercle = pain
42
Q

Interventions for Plantar Fasciitis

A
  • STM during acute phase
  • Stretch gastroc-soleus complex & plantar fascia
  • strengthen intrinsic foot muscles, posterior leg, & neuro reeducation
  • educate patient on footwear & orthotics
  • antipronation taping PRN
43
Q

Acute phase for Planatr Fasciitis

A
  • 1-2 wks
  • stretch gastroc, soleus, & plantar fascia
  • STM on gastroc-soleus complex
  • antipronation taping
  • education on medial longitudinal arch & cushion the heel orthotics & footwear
  • ice: rolling foot over frozen water bottle
44
Q

Subacute phase for Plantar Fasciitis

A
  • wks 3-5
  • stretch gastroc, soleus, & plantar fascia
  • strengthen intrinsic muscles, the ankle in all ROMs, & the gastroc-soleus complex
  • ice: roll foot over a frozen water bottle
45
Q

Subacute phase for Plantar Fasciitis

A
  • wks 3-5
  • stretch gastroc, soleus, & plantar fascia
  • strengthen intrinsic muscles, the ankle in all ROMs, & the gastroc-soleus complex
  • ice: roll foot over a frozen water bottle
46
Q

Return to function for Planatr Fasciitis

A
  • wks 6+
  • stretch gastroc, soleus, & plantar fascia
  • strengthen calf muscles, intrinsics, & all ankle ROMs
  • plyometrics
  • ice: roll foot over frozen water bottle

Theory & Practice II (19 decks)

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